For the use only of Registered Medical Practitioners or a Hospital or a Laboratory INFANRIX Diphtheria Tetanus and Pertussis (Acellular Component) Vaccine (Adsorbed) Ph. Eur. 1. NAME OF THE MEDICINAL PRODUCT Diphtheria Tetanus and Pertussis (Acellular Component) Vaccine (Adsorbed) Ph. Eur. 2. QUALITATIVE AND QUANTITATIVE COMPOSITION One dose (0.5 ml) of vaccine contains: Diphtheria toxoid ------------------- 30 IU Tetanus toxoid ---------------------- 40 IU Bordetella pertussis antigens: Pertussis toxoid ---------------------25 micrograms Filamentous haemagglutinin-------25 micrograms Pertactin-------------------------------8 micrograms The active ingredients are adsorbed on 0.5 mg of aluminium as aluminium hydroxide. For a full list of excipients, see Section 6.1 List of Excipients. 3. PHARMACEUTICAL FORM Suspension for injection. 4. CLINICAL PARTICULARS 4.1 Therapeutic indications INFANRIX is indicated for active primary immunization against diphtheria, tetanus, and pertussis, in children from the age of 2 months and above, or as a booster dose for children previously immunised with three or four doses of either diphtheria, tetanus and acellular pertussis (DTPa) vaccine or diphtheria, tetanus and whole-cell pertussis (DTPw) vaccine. 4.2 Posology and method of administration Posology The recommended dose (0.5 ml) of the vaccine must be administered. 1
As vaccination schemes vary from country to country, the schedule for each country may be used in accordance with the different national recommendations. The primary immunization course consists of 3 doses with boosters during the second and sixth year of life. Method of administration The injection is administered intramuscularly in the anterolateral side of the thigh. INFANRIX should be administered with caution to subjects with thrombocytopenia or a coagulation disorder, due to the risk of bleeding that can occur during intramuscular administration of the vaccine to these subjects. Press the injection site firmly (without rubbing) for at least 2 minutes. INFANRIX should under no circumstances be administered intravenously. 4.3 Contraindications INFANRIX is contra-indicated in children with known hypersensitivity to the vaccine's components or those having shown signs of hypersensitivity after previous administration of INFANRIX or a whole-cell diphtheria, tetanus and pertussis vaccine or a diphtheria and/or tetanus vaccine. INFANRIX is contra-indicated in children having experienced encephalopathy of unknown aetiology which occurred within a period of 7 days following earlier vaccination with a vaccine containing a pertussis valency. In this case, vaccination is to be continued with diphtheria and tetanus valencies. As with other vaccines, the administration of INFANRIX should be postponed in subjects suffering from acute febrile illnesses. The presence of a minor infection is not, however, a contra-indication for immunization. INFANRIX should not be administered after the age of 7, the dose of diphtheria anatoxin should be diminished at this age. 4.4 Special warnings and precautions for use It is advisable to ask about the child's medical history (especially with regard to any undesirable side effects which may have occurred during early vaccination) and to carry out a clinical examination prior to vaccination. Should one of the events mentioned below have arisen previously in temporal relation with the administration of an acellular or whole-cell DTP vaccine, the decision to administer the subsequent doses of the vaccine containing the pertussis component will have to be taken in light of the risks and the expected benefits. There may be instances, on the one hand where the incidence of pertussis may be high, but where on the other hand the risks are low since the previous event did not have any permanent sequelae. 2
The following events were previously considered contra-indications for DTPw and can now be considered general precautions after administration of the INFANRIX vaccine: Temperature equal to or higher than 40.5 C within 48 hours following vaccination, and for which no other cause has been identified. A state of collapse or similar to a shock like state (hyposensitive-hypotonic episode) within 48 hours following vaccination. Persistent and inconsolable crying for more than 3 hours occurring within 48 hours following vaccination. Convulsions with or without fever occurring within the following 3 days after vaccination. Syncope (fainting) can occur after, or even before, any vaccination as a psychogenic reaction to injection. It is important that precautions be taken to avoid injury in the event of fainting. As with all vaccines, the risk/benefit balance for proceeding or postponing vaccination with INFANRIX of an infant or child suffering from a severe neurological illness, whether new or progressive must be assessed carefully. A history of febrile convulsions and a family history of convulsive fits do not constitute a contra-indication for vaccination with INFANRIX. The same applies to HIV infection. As with all injectable vaccines, it is advisable to have a solution of epinephrine at hand for injection in the event of possible anaphylactic reaction (see below for emergency treatment). It is generally advisable to keep the infant under medical supervision for 30 minutes following vaccination. As for all diphtheria, tetanus and pertussis vaccines, the vaccine is to be administered via deep intramuscular injection, preferably by alternate injection sites. INFANRIX is never to be administered intravenously. The potential risk of apnoea with the necessity for respiratory monitoring for 48-72 hours should be carefully taken into account when administering doses of primary vaccination to very premature infants (born at 28 weeks of pregnancy or less), especially in those with a previous history of respiratory immaturity. Due to the high benefit of vaccination in these infants, administration should not be suspended or postponed. 4.5 Interaction with other medicinal products and other forms of interaction INFANRIX may be administered at the same time as other paediatric vaccines; however, a measles vaccine (monovalent or combined) is to be administered either concomitantly or at an interval of 1 month. Different injectable vaccines should always be administered at different injection sites, except HIBERIX which can be mixed with INFANRIX in the same syringe. 3
It is possible that an adequate immunologic response may not be achieved in patients receiving immunosuppressive therapy or suffering from immune deficiency. 4.6 Pregnancy and lactation INFANRIX is not designed for use in adults. 4.7 Effects on ability to drive and use machines INFANRIX is not designed for use in adults. 4.8 Undesirable effects Clinical trials: The safety profile presented below is based on data collected in 20 clinical studies on 11,469 subjects who had received 18,420 doses of the vaccine. As observed for the DTPa and the combinations containing DTPa, an increase in the local reactogenicity and fever was reported after the booster vaccination with the primo-vaccination. The frequencies are as follows: Very common 1/ 10 Common 1/100 and < 1/10 Uncommon 1/ 1000 and < 1/100 Rare 1/10000 and < 1/1000 Very rare < 1/10000 Blood and lymphatic system disorders: Very rare: lymphadenopathy (1) Metabolism and nutrition disorders Common: loss of appetite (2) Psychiatric conditions Very common: irritability Common: agitation (2), abnormal crying Nervous system disorders: Very common: somnolence Uncommon: headache (1) Respiratory, thoracic and mediastinal disorders Uncommon: cough (1), bronchitis (1) Gastrointestinal disorders Common: gastrointestinal disorders such as diarrhoea and vomiting 4
Skin and subcutaneous tissue disorders Common: pruritus Uncommon: rash Rare: urticaria General disorders and administration site conditions: Very common: redness, local swelling at the injection site (<50 mm), fever 38.0 C Common: pain (2), local swelling at the injection site (<50 mm) (3) Uncommon: reactions at the injection site, including induration, fatigue (1), fever 39.1 C, diffuse swelling of the injected limb, sometimes involving the adjacent joint (3). Post marketing surveillance Blood and lymphatic system disorders: thrombocytopenia (4) Immunity system disorders: Allergic reactions, including anaphylactic and anaphylactoid reactions Nervous system disorders: Shock or pseudo shock-like state (hypotonic/hyporesponsiveness episodes), convulsions (with or without fever) within 2 to 3 days of vaccination. Respiratory thoracic and mediastinal disorders Apnoea in very premature infants ( 28 weeks of gestation) - See section 4.4 Special warnings and precautions for use. Skin and subcutaneous tissue disorders Angioneurotic oedema General disorders and administration site conditions: Total swelling of the injected limb (3) (1) Reported only during the booster vaccination (2) Very frequent during the booster vaccination (3) Children who have been given a primo vaccination with an acellular vaccine against pertussis have a greater risk of swelling reactions after the booster is administered than those given a whole cell vaccine against pertussis. Local swelling at the injection site (>50 mm) and diffuse swelling may be more frequent (very common and common, respectively) when the booster dose is administered between 4 and 6 years. These reactions disappear after 4 days on average. (4) Reported with the D and T vaccines. 4.9 Overdose Overdose cases were reported during the post-marketing surveillance. The adverse events, when reported are not specific, but similar to the adverse events reported during normal vaccine administration. 5
5. PHARMACOLOGICAL PROPERTIES 5.1 Pharmacodynamic properties Pharmacotherapeutic group: Bacterial vaccine: code ATC J07 AJ 52. - Immune response to the primary vaccination One month after the primary vaccination (3 doses administered before the age of 6 months), more than 99 % of infants vaccinated with INFANRIX had antibodies titers against diphtheria and tetanus of more than 0.1 IUL/ml. INFANRIX contains three antigens of the pertussis bacillus, which are considered as important for providing protection against this illness, with the immune response to these three antigens being seen to reach 95 % in clinical trials. - Immune response after the fourth dose After the administration of a fourth dose between the ages of 13 and 24 months, all the infants who had already received the first three doses of INFANRIX were seen to have antibodies titers against diphtheria and tetanus of more than 0.1 IUL/ml, with an immune response to these three pertussis antigens being observed in more than 96% of these infants. - Protective efficacy of INFANRIX The protection afforded by a primary INFANRIX vaccination against typical pertussis (as defined by the World Health Organization) was assessed within the context of a prospective blind contact study carried out until the administration of the fourth dose in infants living in secondary contact in families with children with whooping cough (pertussis). Calculated on the basis of the data collected during this study, the effective protection afforded by INFANRIX reached 88.7%, with a bilateral confidence interval of 95%, from 76.6% to 94.6%. 5.2 Pharmacokinetic properties An evaluation of pharrnacokinetic properties is not required for vaccines. 5.3 Preclinical safety data Non-clinical data from conventional safety and toxicity studies have not shown any particular risk for humans. 6. PHARMACEUTICAL PARTICULARS 6.1 List of excipients Aluminium hydroxide, sodium chloride, water for injections. 6
6.2 Incompatibilities INFANRIX should not be mixed with other vaccines in the same syringe, with the exception of HIBERIX. 6.3 Shelf life 36 months The expiry date is indicated in the label and packaging. 6.4 Special precautions for storage Should be stored in a refrigerator between +2 C and +8 C. Do not freeze. Destroy the vaccine if it has been frozen. Protect from light Keep out of reach of children 6.5 Nature and contents of container 0.5 ml suspension for injection in monodose pre-filled syringe (glass type I), fitted with a piston cap. Box of 1, 10 or 25 syringes. All pack presentations may not be marketed in the country. 6.6 Special precautions for disposal and other handling The INFANRIX vaccine is an opaque white suspension in pre-filled syringe. After storage, a white sediment and a clear supernatant can be observed. Before use, the vaccine must be at ambient temperature and must be shaken well to obtain a homogenous, white cloud suspension. The vaccine must be inspected visually before administration to detect any foreign particle and/or alteration of the physical appearance. In case of such a detection or alteration, the product may not be used. If the INFANRIX vaccine is reconstituted from the HIBERIX vaccine, it is necessary to add the entire content of the INFANRIX syringe or vial to the HIBERIX vial. In such a case, the diluent supplied in the HBERIX vaccine package must be discarded and replaced by the INFANRIX vaccine. Once the INFANRIX has been added to HIBERIX, the mix must be shaken well. The combined vaccine is slightly more opaque than INFANRIX alone. If another variation in appearance is observed, do not use the combined vaccine. After reconstitution of 7
HIBERIX with INFANRIX, the vaccine must be injected rapidly by intramuscular path in the anterolateral side of the thigh. Any product not used or any waste must be disposed of according to the regulations in force. 7. MARKETING AUTHORISATION HOLDER GlaxoSmithKline Asia Private Limited Registered Office: Patiala Road, Nabha (Punjab) 147 201. 8. MARKETING AUTHORISATION NUMBER(S) Import Permission No.: Import - 6175/05 9. DATE OF FIRST AUTHORISATION/RENEWAL OF THE AUTHORISATION Date of first authorization: 23 rd September, 2005 For further information please contact: GlaxoSmithKline Pharmaceuticals Limited. Registered office Dr. Annie Besant Road, Worli Mumbai 400 030, India. HIBERIX and INFANRIX are Registered Trademarks of GSK group of companies. Version IFX/PI/IN/2017/01 dated 29 March, 2017. Adapted from Belgian SPC dated 24 th September, 2013 [GDS 13/IPI 06 dated 9 February 2011]. 8